Christina Chow, Sun Helmer, Amber Suzuki

PMH Nurs 320

Group Presentation
March 10, 2014
Personality Disorders
Personality disorders are defined as personality patterns or traits that are inflexible, enduring, pervasive,
maladaptive, and cause significant functional impairment or subjective distress (Fortinash & Worret, 2012).
Signs and Symptoms of Personality Disorders
Cluster A Personality Disorders - described as odd and eccentric (Fortinash & Worret, 2012, p. 303-304)
Paranoid Personality Disorder
-Distrust & suspicion
-Difficulty adjusting to change
-Sensitivity & argumentation
-Anxiety & difficulty relaxing
-Short temper
-Difficulty with problem solving
-Lack of tender feelings toward others

Schizoid Personality Disorder

-Brief psychotic episodes in response to
stressful events
-Lack of desire to socialize; enjoys
solitude
-Lack of strong emotions
-Detached & self-absorbed affect
-Lack of trust in others
-Difficulty expressing anger

Schizotypal Personality Disorder

-Incorrect interpretation of external events
& belief that all events refer to self
-Superstition & preoccupation with
paranormal phenomena
-Anxiety in social situations

Cluster B Personality Disorders may have dramatic behavior (Fortinash & Worret, 2012, p. 303-304)
Antisocial Personality
Disorder
-Irresponsibility
-Involvement in illegal
activities
-Lack of guilt
-Difficulty learning from
mistakes
-Initial charm dissolves
into coldness,
manipulation, & blaming
others
-Lack of empathy
-Abuse of substances

Borderline Personality
Histrionic Personality
Narcissistic Personality
Disorder
Disorder
Disorder
-Suicidal ideation
-Use of suicidal gestures &
-Grandiose view of self
-Self-mutilation
threats when feeling abandoned -Lack of empathy toward
-Impulsivity
-Fluctuation in emotions
others
-Negative or angry affect
-Attention-seeking & self-Need for admiration
-Feelings of emptiness or
centered attitude
-Preoccupation with fantasies
boredom
-Sexual seduction &
of success, brilliance, beauty, &
-Difficulty being alone or
flamboyance
ideal love
feeling of abandonment
-Dramatic & impressionistic
-Intense & stormy relationships speech style

Cluster C Personality Disorders - described as anxious or fearful (Fortinash & Worret, 2012, p. 303-304)
Avoidant Personality Disorder
-Fearful of criticism,
disapproval, or rejection
-Avoidance of social interactions
-Tendency to withhold thoughts
& feelings
-Negative sense of self & low
self-esteem

Dependent Personality Disorder

-Submissiveness & tendency to cling
-Inability to make decisions
independently
-Inability to express negative emotions
-Difficulty following through on tasks

Obsessive-Compulsive Personality Disorder

-Preoccupation with perfection, organization,
structure, & control
-Procrastination
-Excessive devotion to work
-Difficulty relaxing
-Rule-conscious behavior
-Reluctance to delegate
-Inability to discard anything
-Reluctance to spend money

Etiology
Personality disorders are influenced by genetics. It may also be influenced by childhood trauma and
parental neglect. The onset is usually in adolescence or early adulthood (Fortinash & Worret, 2012).
DSM-IV Criteria (Fortinash & Worret, 2012, p. 299)
Axis II
A. Pattern of behavior that is different from expectations of ones culture. The pattern is manifested in
two or more of the following areas: cognition; affectivity; interpersonal functioning; impulse control
B. Pattern is inflexible and spans across a broad range of personal and social situations.
C. Pattern leads to distress or impairment in social, occupational, or other important areas of
functioning.
D. Pattern is stable and chronic, and its onset can be traced back to adolescence or early adulthood.
E. Pattern is not a manifestation or consequence of another mental disorder.
F. Pattern is not due to the direct physiologic effects of a substance or a general medical condition.
Statistics
According to the National Institute of Mental Health (2014), approximately 9.1% of the general US
population has a personality disorder. Antisocial, avoidant, and borderline personality disorder are three
of the more common types of personality disorders. Approximately 1% of people over 18 years old have
antisocial personality disorder, 5.2% have avoidant personality disorder, and 1.6% has borderline
personality disorder.
Cost to Society
They have difficulty functioning at home, work, and in relationships. People with severe personality
disorders are high-cost, chronic, and intensive users of mental health services. According to the National
Institute of Mental Health (2008), major mental health disorders cost United States about $193 billion a
year.
Psychopharmacology
According to Hogan et al. (2008), antipsychotic agents may be prescribed on a short-term basis and
psychopharmacotherapy can be used to improve specific symptoms of personality disorder.
- Selective serotonin reuptake inhibitors (SSRIs): Anti-depressants to help to regulate depression and
self-destructive behavior associated with borderline and antisocial personality disorder
- Anxiolytics may be prescribed to relieve anxiety symptoms
- Mood stabilizers and/or antipsychotics may be used to regulate emotions and decrease impulsiveness
and anger
National Initiatives
National Education Alliance Borderline Personality Disorder (2014) developed a program designed for
the family members of persons with Borderline Personality Disorder.
- Family Connections: a 12-week course; weekly meeting provide education and provide support to
people who are in a relationship with someone who have personality disorder.
- Family TeleConnections: an option specifically for families living far from family connections
meeting locations; using email and online discussion
Implications of Care
People with personality disorders are often high users of health resources and demands for care can be
great. According to New York-Presbyterian Hospital (2009), between 60 to 70 percent of individuals

with borderline personality disorder attempt suicide. Also, BPD has about 10 percent rate of death by
suicide. Assessment for acute risks is important to managing their care, knowing that impulsive &
suicidal behaviors are a cry of distress. Health care professionals must maintain therapeutic
relationships with these patients and avoid personalizing their reactions.
Emphasis on patient education, compliance, and support systems are the keys in success of treating
someone with a personality disorder.
Evidence - Based Article
Amminger et al. (2013) found that omega-3 fatty acids significantly improved functioning and reduced
psychiatric symptoms compared with placebo.
What is working vs. what is not working?
According to the National Institute of Mental Health (2014), personality disorders are difficult to
diagnose and many times this condition is misdiagnosed or under diagnosed. A thorough interview and
discussion about symptoms by an experienced mental health professional can detect a personality
disorder, but a thorough medical exam must also be done to rule out any other causes of symptoms.
Lack of productivity
The National Institute of Mental Health (2014), states that science is still working to improve diagnosis
and treatment of personality disorders. There is no single test that can definitively diagnose someone
with a personality disorder. Other studies such as neuro imaging are showing differences in brain
structure and activity in people thought to have this disorder that may aid in improving treatment
regimens. Patients with personality disorders can be treated inpatient or outpatient depending on the
severity of their condition. Upon discharge of these patients it is important to make sure they are
properly educated and prepared.
Discharge considerations for an inpatient/outpatient (Fortinash & Warrett, 2012., p.305-306)
Does the patient know what symptoms to be aware of and when to seek emergent care?
Does the patient understand what medications they are taking, the side effects, and why it is
important to stay compliant?
If inpatient, do they acknowledge the need for follow-up care in an outpatient setting?
Does the patient still have active thought of harm to self or others?
Can the patient control self-destructive thoughts and impulses?
Does the patient know what symptoms caused the need for therapy?
Can the patient recognize and understand symptoms that require further, future treatment?
Can the patient use and are they aware of 12-step groups that are relevant to their problems?
Psychotherapy is the main treatment for personality disorders. Treatment requires a trust-based
relationship between patient and therapist to be established to make therapy effective.
Types of Psychotherapy: (Fortinash & Warrett, 2012., p.304-305)
Cognitive Behavioral Therapy (CBT)
CBT changes thought process and behavior when patient is faced with a stressor.
Dialetical Behavioral Therapy (DBT)
DBT involves use of dialogue to correct negative behavioral responses to certain situations.
Schema-focused Therapy
Schema-focused therapy is used with CBT and focuses changing the patients self-image.

Where can I get help? (nimh.nih.gov, 2014)

- Mental health professionals (psychiatrists, psychologists, social workers, mental health counselors)
- Health maintenance organizations
- Community mental health centers
- Local medical and psychiatric societies
- Peer support groups
Suggestion for Nursing Care
Effective treatment of BPD is non-judgmental approaches and understanding individual;
adequate supervision is also essential.
In clinical, negative and critical attitudes of staff lead to unempathic and unhelpful responses
toward clients and tend to increased behavioral disturbance.
Establish conditions that keep the patient safe
Treatment of psychiatric symptoms with medication when necessary
Provide support and resources that are available in the community
Community resources
State Behavioral Health Agency
Department of Health
Adult Mental Health Division 1250 Punchbowl #256 Honolulu, HI 96813
Phone: 808-586-4686
Fax: 808-586-4745
E-mail: admin@amhd.org Internet: http://www.amhd.org
State Protection and Advocacy Agency
Hawaii Disability Rights Center 1132 Bishop Street, Suite 2102 Honolulu, HI 96813
Phone: 808-949-2922 (TDD) Toll-free: 800-882-1057
Fax: 808-949-2928
E-mail: info@hawaiidisabilityrights.org
Internet: http://www.hawaiidisabilityrights.org
Family Support
Hawaii Families As Allies
99-209 Moanalua Road, Suite 305 Aiea, HI 96701
Phone: 808-487-8785
Toll-free: 866-361-8825 (Warm line) Fax: 808-487-0514
E-mail: hfaa@hfaa.net
Internet: http://www.hfaa.net

References
Amminger, G., Chanen, A. M., Ohmann, S., Klier, C. M., Mossaheb, N., Bechdolf, A., & ...
Schfer, M. R. (2013). Omega-3 Fatty Acid Supplementation in Adolescents With
Borderline Personality Disorder and Ultra-High Risk Criteria for Psychosis: A Post Hoc
Subgroup Analysis of a Double-Blind, Randomized Controlled Trial. Canadian Journal Of
Psychiatry, 58(7), 402-408.
Fortinash, K., & Holiday Worret, P. (2012). Psychiatric mental health nursing, (5th ed.). St
Louis: Elsevier Mosby.
Hogan, M. A., Gaylord, C., Gruener, R., Rodgers, J., Zalice, K. K. (2008). Mental Health Nursing.
Reviews & Rationales. Personality Disorders.164
National Education Alliance Borderline Personality Disorder. (2014). About BPD. Retrieved from
http://www.borderlinepersonalitydisorder.com/
National Institute of Mental Health. (2014) Borderline Personality Disorder. Retrieved from
http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml#p ub7
National Institute of Mental Health. (2008). Mental disorders cost society billions in unearned income.
Retrieved from http://www.nimh.nih.gov/news/science-news/2008/mental-disorders-costsociety-billions-in-unearned-income.shtml
National Institute of Mental Health. (2014). The numbers count: mental disorders in America.
Retrieved from
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-inamerica/index.shtml
New York-Presbyterian Hospital. (2009). Preventing Suicide in Patients with Borderline Personality
Disorder. Retrieved from http://nyp.org/enews/preventing-suicide-bpd-patients.html
Substance Abuse and Mental Health Services Administration. (2012). Hawaii-State Resource
Guide. Retrieved from http://store.samhsa.gov/product/Hawaii-State-Resource-Guide/SRG-HI